Provider Demographics
NPI:1336996883
Name:EMPOWERED BEAUTY & WELLNESS CLINIC LLC
Entity type:Organization
Organization Name:EMPOWERED BEAUTY & WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIJA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:956-513-5415
Mailing Address - Street 1:1114 GOODRICH DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2704
Mailing Address - Country:US
Mailing Address - Phone:956-513-5415
Mailing Address - Fax:
Practice Address - Street 1:2812 W NOLANA AVE STE 160-B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4185
Practice Address - Country:US
Practice Address - Phone:956-513-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center